Recent lab results - need your HELP!

[RobInPA]

I am in month 5 of my acute hep b. When I first visited my GI back at the end of September, he told me to come back to see him in December and that if the antibodies still didn't develop and I was still positive, he "wasn't going to worry that much."  He said that he would be worried in February (when the 6-month time frame ended). I just went back to see him yesterday (12/27) and he immediately told me that he is "very concerned" and when I asked him what his gut feeling is about my condition he told me that he is pretty sure that my hep b will become chronic. My head was spinning (and still is) because I am not sure why his prognosis changed. My latest lab results are:
AST=44 (still a bit elevated), ALT=53, ALK=139.  My hep B surf antibody was negative, hep B surf antigen was positive, my hep B e antibody was negative and my hep B e antigen was positive.  I know that the antibody should be positive and the antigen should be negative so I wasn't happy with the results. However, my surf antibody was "less than 2" when I had it done in August. It's now at a 4.  I know that it has to be at a 10 in order for it to be positive for the antibody which will kill the virus. My primary care physician also has received my lab results and he told me that I was on my way to "full recovery" and wrote "better yet" on the lab results for the surf antibody test. My GI wants to put me on treatment (entecavir) NOW.  I told him no and that I wanted to wait the full 6 months. He said fine but that once the 6 months is over and the tests are still not favorable, he wants me to put me on the entecavir right away. I am so confused for many reasons. First of all, the 6 months isn’t over and I heard  that sometimes it takes longer than 6 months to develop the antibodies. Second of all, why is my primary care physician saying “full recovery” and “better yet?” Is he saying this because my surf antibody went from less than 2 to a 4?  Is there a chance that this can go to a 10 in a month or maybe two months?  I am really at a loss and don’t want to jump right into taking entecavir. Can anyone help with some advice? I really appreciate it.

[Bm2016]

I'be switched medication a few times, from viread to truvada and back and forth a few time due to unknown reason of elevated alt, dr. always want a 2month blood report to make sure kidney and other organs are ok.

[itac]

Yes maybe waiting is a good idea? What evidence that taking antiviral late in the acute phase will prevent it becoming chronic? Are there actual studies that back it up? If not, aren't you risking using life long treatment once you start taking it? I mean if it does become chronic and since you start treatment, you won't be able to start? Not sure what are guidelines in your case but I would do some research...

[itac]

*Not able to stop

[RobInPA]

Thanks, itac. I am waiting to see what the results are of my DNA tests so I can see where my viral load is at. Do you know...or does anyone else know the answer to this question:  Once you start treatment (like entecavir), can you ever stop and switch to something else? My hope is that there will be a drug coming out in the near future that will cure this and was wondering if I could switch to something like that if it ever comes out. I am even going to research clinical trials. There has to be something out there better than the standard of care that is on the market already.

[24CN]

There are some drugs in phase two now being tested for efficacy as monotherapy and in combination with nucs and interferon. I can't speak to the entry criteria for these trials, or any trials occurring in the future, but I also can't see a doctor recommending that you prioritise these solely for the purpose of remaining treatment naive. StephenCastlecrag knows his stuff, quantify your viral load, wait out the six months and take it from there (if at all required).

[StephenCastlecrag]

Before you do anything, you should check your viral load (hbvdna). We cannot tell whether you are chronic for a while, or acute going to clear, or acute becoming chronic. Just wait a few months, check your serology and hbvdna. You should have a clearer picture then.

[RobInPA]

Thanks for getting back to me, StephenCastlecrag. I did get my HBVDNA test but I haven't received the results yet. My GI is on vacation until next Tuesday so hopefully I will have them back by then.